Surgical aiming device

ABSTRACT

A hinged pivoting guide for positioning a femoral tunnel in anterior cruciate ligament (ACL) reconstruction locates a drilling hole for placement that optimally penetrates a minimal depth of soft tissue (skin, muscle, etc.) yet directs drilling into a sufficiently rigid and structurally sound area of the femur. The hinged guide allows placement of an aimer point at a desired drilling exit location on the femur. The hinge is adapted to secure the aimer at a degree of rotation about an axis defined by the hinge rotation, such that the axis passes through the aimer point throughout rotation of the hinge while maintaining the aimer point in line with an insertion guide slideably movable through the aperture in the handle, the aperture defined by an insertion axis extending toward the aimer point such that the aimer point remains disposed at the intersection of the hinge axis and the insertion axis.

BACKGROUND

Reconstructive bone and ligament surgery often involves drilling intoskeletal members to attach connective elements such as ligament andtendon grafts, as well as various artificial replacements and/orattachments for articulated joints. In particular, reconstructivesurgery involving the anterior cruciate ligament (ACL) is becomingparticularly significant because the effectiveness of reconstruction canhave a profound effect on the subsequent athletic ability of thepatient. For professional athletes, for example, an effective ACL repaircan salvage an otherwise career ending injury. Similarly, an improperlytreated ACL injury can be a permanent detriment even to an amateurathlete.

SUMMARY

Reconstructive surgery involving functional, structural fixation to bonemembers often involves drilling into a structurally sound area of thecorresponding bone. In an ACL repair, antegrade drilling of the femur isbecoming more common. A damaged ACL is often replaced with a graft froma patellar tendon or a semitendinosus tendon. Such a repair isfacilitated by tunnels formed in the tibia and femur for use inimplanting the graft in the patient's knee. Recent studies suggest moreaccurate placement is achievable by such antegrade femoral drilling thanby conventional approaches such as drilling the femoral tunnel throughthe tibial tunnel. The graft may then be secured in the tunnels byfixation means, such as, for example, interference screws or suturestied to screw posts. The femur, in particular, is often subjected tomore substantial forces because it often bears the entire weight of thepatient, and being the largest human bone, may be relied upon toaccommodate a substantial connective force from a surgically addedstructure.

Configurations herein are based, in part, on the observation thatconventional arrangements for surgical or arthroscopic drilling rely ona fixed aimer that may impede positioning of the handle and insertionguide for optimal positioning of a drill hole at an insertion point. Anoptimal placement defines a point of entry for a drilling hole thatdisplaces minimal soft tissue depth while engaging a rigid structure(such as a knee bone) at a structurally sound location. Conventionalapproaches using such a fixed, rigid aimer hinder the ability to achieveoptimal interarticular tunnel placement.

In ACL reconstruction involving such drilling, therefore, attachment ofstructural surgical tethers, such as grafts and artificial connectors,should be performed at a structurally sound location on the femur.Configurations herein disclose a drilling guide adapted for positioninga drilling tunnel in (ACL) reconstruction. Typically, a drilling guideadapted for insertion into a joint region locates a drilling exit point,while a surgeon manipulates the handle of the drilling guide to locatean entry location. Unfortunately, conventional arrangements suffer fromthe shortcoming that drilling guides for directing placement of thedrilled hole are universal, in that a single straight design having afixed relation of an aimer arm and a handle identify a point ofdrilling. Conventional approaches, therefore, do not distinguish a leftfrom right knee, nor individual differences in the bone configuration ofan individual patient, which compromises the ability to manipulate thedrilling guide to pivot around the aimer arm for locating an optimalentry point for drilling. Conventional mechanisms employ a fixed aimerincapable of rotational or pivoting movement around a hinge connectionto the arm denoting the drilling exit point. Such arrangements mayattempt a similar range of application by employing fixed left and rightguides, or a series of fixed angle guides for both right and leftapplication, however this would result in a trial and erroradministration as well as requiring manufacturing of a range of multiplefixed angle guides.

Configurations herein substantially overcome the above describedshortcomings by employing a hinged pivoting guide for positioning afemoral or tibial tunnel, for example, in anterior cruciate ligament(ACL) reconstruction. Locating the drilling hole for placement of thetunnel optimally penetrates a minimal depth of soft tissue (skin,muscle, etc.) yet directs drilling into a sufficiently rigid andstructurally sound area of the femur. The hinged guide allows placementof an aimer point at a desired drilling exit location on the femur. Thehandle includes an aperture indicative of the drilling location, and asurgeon may manipulate the handle by pivoting around the hinge todispose the aperture at an optimal location while maintaining the sameexit location defined by the aimer point. In this manner, an optimaldrilling location is selectable by positioning the handle to an area ofminimal soft tissue depth and in line with a structurally sound paththrough the femur.

In further detail, the surgical aiming device as disclosed hereinincludes a handle coupled to a proximate end of an elongated arm, inwhich the elongated arm further has a distal end, and a hinge securingan aimer to the distal end for rotational communication around a hingeaxis. The aimer has an elongated aimer tip and an aimer point, such thatthe aimer point is at a distal end of the aimer tip from the hinge, andthe aimer tip couples to the arm via the hinge at a proximate end. Thehinge is adapted to secure the aimer at a degree of rotation about anaxis defined by the hinge rotation, such that the axis passes throughthe aimer point throughout rotation of the hinge while maintaining theaimer point in line with an insertion guide slideably movable throughthe aperture in the handle, in which the aperture defines an insertionaxis extending toward the aimer point such that the aimer point remainsdisposed at the intersection of the hinge axis and the insertion axis.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of theinvention will be apparent from the following description of particularembodiments of the invention, as illustrated in the accompanyingdrawings in which like reference characters refer to the same partsthroughout the different views. The drawings are not necessarily toscale, emphasis instead being placed upon illustrating the principles ofthe invention.

FIG. 1 shows a side view of the surgical aiming device as disclosedherein;

FIG. 2 shows a perspective view of the surgical aiming device of FIG. 1;

FIG. 3 shows a side view of the surgical aiming device as in FIG. 1 witha partially extended arced section;

FIG. 4 shows an opposed side view of the surgical aiming device of FIG.1;

FIG. 5 shows an alternate view of the surgical aiming device of FIG. 4having a partially extended arced section and disengaged arm;

FIG. 6 shows a perspective view of the aimer arm disposed at a surgicalsite;

FIG. 7 shows an exploded view of the arm of FIG. 1; and

FIGS. 8-9 show a procedural sequence employing the surgical aimingdevice of FIG. 1.

DETAILED DESCRIPTION

Disclosed below is an example configuration and deployment of thesurgical aimer arm. In an example arrangement, an ACL repair employingthe surgical aiming device for femoral drilling is shown. Alternateconfigurations may employ placement on other skeletal structures, or onsofter tissue surfaces, and may or may not employ a drilling approachfor excavating the insertion tunnel for a guidewire.

FIG. 1 shows a side view of the surgical aiming device 100 including ahandle 102 having a slot 104 defining an arc 106. The handle 102 isshaped for a secure grasp by a surgeon or other operator. An arm 110 hasan arced section 112 and a straight section 114. The arced section 112is shaped to slideably engage with the slot 104 in the handle 102 formovement according to arrow 116. The straight section 114 has a hinge120 for securing an aimer 130 to the straight section 114 at the opposedend distal from the arced section 112. The hinge 120 adapts the aimer130 for rotational communication with the straight section 114 around ahinge axis 122, as shown by arrow 124. The hinge 120 secures the aimer130 via a screw 126 or other suitable pivotal coupling around the hingeaxis 122.

The aimer 130 includes an elongated aimer tip 132 extending from thehinge and an aimer point 134 at a distal end of the aimer tip 132 fromthe hinge 120. The aimer tip 132 couples to the straight section 114 viathe hinge 120 at a proximate end. The handle 102 further includes aninsertion guide 140 adapted for slideable movement within an aperture144 in the handle 102 along an insertion axis 142. The insertion guide140 has slanting teeth 146 for selective ratcheting engagement with apawl 148 when the insertion guide 140 is rotated via an insertion knob149 such that the teeth 146 engage the pawl 148. The insertion axis 142passes through the aimer point 134 at an intersection 150 of the hingeaxis 122, thus the aimer tip 132 extends such that the aimer point 134is disposed on the insertion axis 142 throughout the range of rotation124 of the aimer 130.

The arm 110 is adapted for arcuate movement relative to the handle 102as defined by the arc 106, shown by arrows 116. The aimer point 134 isthe center of a circle defining the arc 106 in the handle 102 throughwhich the arced section 112 slideably engages, thus the aimer point 134retains its position at the intersection 150 during the arcuate movement116. Further, as the hinge 120 is adapted to secure the aimer 130 at adegree of rotation about an axis 122 defined by the hinge 120 andpassing through the aimer point 134, the aimer point remains at theintersection 150 throughout movement of the arm 130 and arced section112.

The insertion guide 140 has a hollow core (176, FIG. 6 below) forsubsequent guidewire access, discussed further below. A taper,serration, or other suitable engaging edge on the tip 141 of theinsertion guide facilitates identification of an incision point, andsubsequently for engaging a bone or other hard surface for fixing theinsertion guide for the guidewire. Typically a soft tissue incision ismade where the tip 141 contacts soft tissue, the insertion guide 140inserted until hard material (i.e. bone) is encountered, and the tipengages the bone facilitated by the ratcheting action to avoid slippageduring guidewire insertion.

FIG. 2 shows a perspective view of the surgical aiming device of FIG. 1.Referring to FIGS. 1 and 2, the handle 102 includes apertures 103 forweight reduction. The insertion guide 140 is extendable to the aimerpoint 134 to define a drilling and/or insertion hole for a guide wirealong the insertion axis 142 through a range from the aperture 144 inthe handle to the aimer point 134. A pivot knob 127 rotates the hingescrew 126 (arrow 125) for securing and releasing the hinge 120 atvarious degrees of rotation (pivot) through a range, shown at a pivotangle 124. The arced section 112 is fixable by fixation knob 113.

FIG. 3 shows a side view of the surgical aiming device as in claim 1with a partially extended arced section 112. Referring to FIGS. 1 and 3,the arced section 112 is partially extended exposing the apertures 103in the handle 102. The insertion axis 142 and hinge axis 122 stillintersect 150 at the aimer point 134, since the arm 110 travels along anarc 116 on the circle 152 with the aimer point 134 at the center.

FIG. 4 shows an opposed side view of the surgical aiming device ofFIG. 1. Referring to FIGS. 1 and 4, the aperture 144 in the handle isvisible showing the slanting teeth 146 providing ratcheting movement tothe insertion guide 140. The hollow core 176 of the insertion guide 140allows passing of a guidewire 154 (FIG. 6, below) through an insertiontunnel 174 formed from rotation of the insertion guide 140 or from aseparate drilling device.

FIG. 5 shows an alternate view of the surgical aiming device of FIG. 4having a partially extended arced section 112 and disengaged arm 130.The partial extension of the arced portion 112 of the arm 110 is shownby the apertures 103 only partially obscured by the arced portion 112.The hinge 120 employs the securing screw 126 for securing the arm 130,shown detached with a threaded portion of the securing screw 126visible.

FIG. 6 shows a perspective view of the surgical device 100 disposed at asurgical site. As indicated above, ACL repairs often involve surgicaldrilling through the femur 160 and tibia 162 for passing a guidewire 154through the insertion guide 140. Referring to FIGS. 1 and 6, an exampleof using the surgical aiming device 100 for such an application isshown. The surgeon disposes the aimer point 134 at a target location 170within the surgical site, such as an anatomically sound location on thefemur 160. Typically this would be the same location as the priorattachment of the ligament being repaired, but other suitable locationsmay be marked/aimed. The surgeon frees the securing mechanism of thehinge 120 such as by loosening the hinge knob 127, and disposes the arm110 and handle 102 to a suitable location for drilling as defined by anincision point and corresponding drilling site 172 (note that theincision point often defines a soft tissue location along the insertionaxis for insertion of the insertion guide towards the drilling site172). A serrated or tapered edge at the tip 141 of the insertion guide140 passes soft tissue, and contacts the drilling site 172 at the bone,cartilage, or other hard surface. The tip 141 is formed so as to engagethe bone surface after penetrating the soft tissue through theinsertion, and may be a pyramidal, serration, or tapered edge, forexample. A drill may subsequently be employed to further excavate aninsertion tunnel 174, formed from the guide wire 154 passing through thehollow core 176 of the insertion guide 140.

FIG. 7 shows an exploded view of the arm 110 of FIG. 1, showing tickmarkings 113 metering arcuate extension of the arced portion 112, andthe separation of the hinge 120 rotationally securing the straightportion 114 of the arm 110 to the aimer 130.

FIGS. 8-9 show a procedural sequence employing the surgical aimingdevice of FIG. 1. Referring to FIGS. 1 and 8-9, locating an optimalinsertion point allows locating the aimer point 134 at a targetlocation, and manipulating the handle 102 via pivoting of the hinge 120and sliding the arced section 110 to dispose the insertion guide 140accordingly, as follows.

A method for surgical drilling using the surgical aiming devicedisclosed herein includes, at step 200 engaging a handle 102 having aslot 104 defining an arc 106 in a surgical field for defining a drillinghole 174 by disposing an arm 110 having an arced section 112 and astraight section 114, such that the arced section 112 slideably engageswith the slot 104 in the handle 110 for arcuate movement therein, asdepicted at step 201.

The arm 110 hindgedly attaches to the aimer 110 having an elongatedaimer tip 132 and an aimer point 134, such that the aimer point 134 isat a distal end of the aimer tip 132 from the hinge 120, and the aimertip 132 couples to the straight section 114 via the hinge 120 at aproximate end, as disclosed at step 202.

An operator pivots the hinge 120 securing the aimer 130 to the straightsection 114 distal from the arced section 112 for rotationalcommunication with the straight section 114 around a hinge axis 122, asshown at step 203. The hinge axis 122 passes through the aimer point 134throughout a range of motion 116 of the arced section 112 through theslot 104, as depicted at step 204. The aimer point 134 remains definedby the center of a circle 152 defining the arc 106 in the handle throughwhich the arced section 112 slideably engages, as disclosed at step 205.The surgeon or operator disposes, via the pivoting, the aimer tip 134 ata placement point 170 along the axis 142 defining an insertion path, asshown at step 206. The hinge 120 is adapted to secure the aimer 130 at adegree of rotation 124, such that the degree of rotation 124 is about anaxis 122 defined by the hinge 120 and passing through the aimer point134, as depicted at step 207. The hinge axis 122 is defined by asecuring mechanism, such that the rotational communication 124 is aboutthe axis 122 defined by the securing mechanism, and the degree ofrotation 124 is fixable by the securing mechanism, as shown at step 208.In the example arrangement, the securing mechanism is provided by thesecuring screw 126 and knob 127, however alternate securementarrangements may be employed.

The operator or surgeon disposes the insertion guide 140, such that theinsertion guide 140 is slideably movable through an aperture 144 in thehandle 110. The aperture 144 defines an insertion axis 142 extendingtoward the center of a circle 152 defined by the arc 106, as disclosedat step 209. This includes, at step 210, wherein the aperture 144 axispasses through the aimer point 134, as the insertion guide 140 isdisposed toward the aimer point 134. This allows marking and fixing, viathe edge at the tip 141 of the insertion guide 140, an optimal insertionpoint 172. The optimal insertion point 172 lies on the insertion axiswhere the insertion guide 140 meets bone, and the edge of the tip 141allows fixing the insertion guide 140 against the bone for guidewire 154insertion. The hinge axis 122 and the insertion axis 142 thereforedefine a placement point 170 representative of an optimal insertionpoint on the insertion axis 142 for surgical entry, in which the aimerpoint 134 of the arm disposed at the placement point 172 (targetlocation), as depicted at step 211.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the spirit and scope of the presentapplication as defined by the appended claims. Such variations areintended to be covered by the scope of this present application. Assuch, the foregoing description of embodiments of the presentapplication is not intended to be limiting, the full scope rather beingconveyed by the appended claims.

1. A surgical aiming device comprising: a handle coupled to a proximateend of an elongated arm, the elongated arm further having a distal end;a hinge securing an aimer to the distal end for rotational communicationaround a hinge axis; the aimer having an elongated aimer tip and anaimer point, the aimer point at a distal end of the aimer tip from thehinge, the aimer tip coupled to the arm via the hinge at a proximateend; and the hinge adapted to secure the aimer at a degree of rotationabout an axis defined by the hinge rotation, the axis passing throughthe aimer point.
 2. The device of claim 1 further comprising: anaperture in the handle; and an insertion guide slideably movable throughthe aperture in the handle, the aperture defined by an insertion axisextending toward the aimer point.
 3. The device of claim 2 wherein thehinge axis and insertion axis define a placement point representative ofan optimal insertion point along the insertion axis for surgical entry,the aimer point of the arm disposed at the placement point.
 4. Thedevice of claim 3 wherein the intersection of the hinge axis and theinsertion axis defines the placement point, the optimal insertion pointbeing on the insertion axis where the insertion axis intersectsextractable material, the hinge axis orthogonal to the insertion axisfor rotational positioning.
 5. The device of claim 4 wherein the hingeaxis is defined by a securing screw, the rotational communication beingabout an axis defined by the securing screw, the degree of rotationfixable by the securing screw.
 6. The device of claim 1 wherein theelongated arm has an arced section and a straight section, the hingesecuring the aimer to the straight section distal from the arcedsection, the aimer point defined by the center of a circle defining thearc in the arced section.
 7. The device of claim 6 wherein the handlehas a slot corresponding to the arced section, the arced sectionslideably engaging with the slot in the handle for arcuate movementrelative to the aimer point.
 8. The device of claim 7 furthercomprising: an aperture in the handle; and an insertion guide slideablymovable through the aperture in the handle, the aperture defined by aninsertion axis extending through the aimer point.
 9. The device of claim8 wherein the slot frictionally secures the arced section in the slotfor fixing the aimer tip relative to the insertion guide.
 10. The deviceof claim 9 wherein the insertion guide has an engaging edge at a tip andis disposable along the insertion axis toward the optimal insertionpoint, the optimal insertion point responsive to drilling from theengaging edge of the insertion guide.
 11. A surgical aiming devicecomprising: a handle having a slot defining an arc; an arm having anarced section and a straight section, the arced section slideablyengaging with the slot in the handle; a hinge securing an aimer to thestraight section distal from the arced section for rotationalcommunication with the straight section around a hinge axis; the aimerhaving an elongated aimer tip and an aimer point, the aimer point at adistal end of the aimer tip from the hinge, the aimer tip coupled to thestraight section via the hinge at a proximate end; the hinge adapted tosecure the aimer at a degree of rotation, the degree of rotation beingabout an axis defined by the hinge and passing through the aimer point;and the aimer point defined by the center of a circle defining the arcin the handle through which the arced section slideably engages.
 11. Thedevice of claim 10 wherein the hinge axis passes through the aimer pointthroughout a range of motion of the arced section through the slot. 12.The device of claim 11 further including an insertion guide slideablymovable through an aperture in the handle, the aperture defining aninsertion axis extending toward center of circle defined by the arc. 13.The device of claim 12 where the aperture axis passes through the aimerpoint, the insertion guide adapted for rotation around the insertionaxis as the insertion guide is disposed toward the aimer point.
 14. Thedevice of claim 13 wherein the hinge axis and the insertion axis definea placement point representative of an optimal insertion point in theinsertion axis for surgical entry, the aimer point of the arm disposedat the placement point.
 15. The device of claim 14 wherein the hingeaxis is defined by a securing screw, the rotational communication beingabout an axis defined by the securing screw, the degree of rotationfixable by the securing screw.
 16. A method for surgical drilling,comprising: engaging a handle having a slot defining an arc in asurgical field for defining a drilling hole; disposing an arm having anarced section and a straight section, the arced section slideablyengaging with the slot in the handle for arcuate movement therein;pivoting a hinge securing an aimer to the straight section distal fromthe arced section for rotational communication with the straight sectionaround a hinge axis, the aimer having an elongated aimer tip and anaimer point, the aimer point at a distal end of the aimer tip from thehinge, the aimer tip coupled to the straight section via the hinge at aproximate end, the pivoting disposing the aimer tip at a placement pointalong an axis defining an insertion path; the hinge adapted to securethe aimer at a degree of rotation, the degree of rotation being about anaxis defined by the hinge and passing through the aimer point; and theaimer point defined by the center of a circle defining the arc in thehandle through which the arced section slideably engages.
 17. The methodof claim 16 wherein the hinge axis passes through the aimer pointthroughout a range of motion of the arced section through the slot. 18.The method of claim 17 further including: disposing an insertion guide,the insertion guide slideably movable through an aperture in the handle,the aperture defining an insertion axis extending toward the center of acircle defined by the arc.
 19. The method of claim 18, the disposingfurther comprising, wherein the aperture axis passes through the aimerpoint, advancing the insertion guide along the insertion axis as theinsertion guide is disposed toward the aimer point.
 20. The method ofclaim 19 further comprising marking, via an engaging edge in theinsertion guide, an optimal insertion point, wherein the hinge axis andthe insertion axis define a placement point representative of an optimalinsertion point on the insertion axis for surgical entry, the aimerpoint of the arm disposed at the placement point.
 21. The method ofclaim 20 wherein the hinge axis is defined by a securing mechanism, therotational communication being about an axis defined by the securingmechanism, the degree of rotation fixable by the securing mechanism.